are more commonly make up a larger proportion of covid-19 cases 16 and over. despite the fact they make up a smaller number of cases. and then you see the sexual orientation and gender percentages here as well. next slide. our key health indicators, hospital capacity, and rate of increase in hospitalizations are in the green territory, very favorable. our case rate at 4.3 in the moderate alert zone. that had dropped down to a low of 3.3% into the low alert yellow zone now back up to 4.3%. our testing numbers rate with the rest of the country has

decreased since november and december. we're still doing over 5,000 tests today. our contract tracing numbers are increasing as the team has a greater ability to reach all cases. 88% and 85% and our ppe supply remains robust. next slide. hospitalizations, dramatic decrease in hospitalizations. yesterday, we hit a new low of 20 people in the hospital due to covid-nineteen and just three in the intensive care unit. this is actually the lowest number we've been able to track since last spring. during the very beginning of that spring surge, so a very positive. remember that hospitalizations lag cases by about two weeks, so we may see some increase in these numbers even with our relatively robust vaccine

efforts. next slide. i'll just give a few general vaccine numbers and mr. pickens will go into more detail. i'm really pleased to say that fifty% of san franciscans have received at least one vaccine dose at this time. 30% nearly 1/3 has completed a vaccine series. so this is great news. and you see on this chart here how rapidly our vaccine numbers have improved. i will say that right now, we are averaging about 12,000 vaccines a day going into arms. remember, we had set the goal of 10,000 a day initially. we now have capacity to do over 20,000 vaccines. so we are continuing to work to get more vaccine into the city. you can see our numbers are significantly better than in the u.s. or california overall.

are 50% and 30% compared to about 42% and 24%. and, again, our rolling day average is approved even since this slide was prepared last week. some other land marcs is that we have surpassed 200,000 vaccinations at moscone site. with that health network, we have surpassed 100,000 vaccines in getting those vaccines into arms and communities most affected by covid-19 and mr. pickens will provide more detail of that. i believe that's my last slide. i am happy to take questions or turn it over to mr. pickens for a deeper dive into the vaccine work. >> president bernal: before we

go into commissioners' questions or comments on the director's report or update report, mark,

>> good evening commissioners. it's my pleasure to present this update on covid-19 vaccinations within san francisco. and i'll start by saying i am here representing a whole codre of workers, the department of

public health, other city departments. many of our c.b.o.s and other health systems and clinics throughout the city. this is truly a collaborative effort while d.p.h. is the main convener and organizer, we are not doing this work alone and it's truly a reflection of the partnership of all of san francisco that we've achieved the results that you heard a little bit about already and hopefully we'll be able to share with you throughout the rest of this presentation. so, next slide. so as we began our work on vaccine in late november and december, we felt it was very important that we be as transparent as possible with the public in terms of the available data that was available at the time that would be coming forward. so this is just a small snapshot of one of the pieces

of public data that is available on our website that any member of the public may access at any time. next slide. so you'll remember when we come to you in the past, you know, our goal from the very beginning is to make sure that we vaccinate 100% of the san francisco population. so we've set that goal at 900,000 individuals representing, of course, san francisco residents and then those that who are not residents, but spend a lot of time within the city. as you heard from dr. colfax, we just through the data run yesterday achieved having had 50% of our population of eligible individuals and, at this time, that is individuals over sixteen years of age

who've received at least one dose of vaccine. so, again, this is a result of the herculean efforts of many individuals, organizations, and communities across san francisco. in this slide, this gives you an indication of the number of vaccines that have been administered to date in san francisco. a little over 600,000. and, in terms of vaccines administered to san francisco residents, almost 400,zero residents have received one dose and of those almost 400,000, about 70,000 of those were administered by the department of public health through our network and our clinics at moscone. and, just to remember, the reason you see a difrnts between those numbers, vaccines administered in san francisco includes not only our

residents, but also individuals who work in san francisco, for example, those who work in health care and who are some of the very first to be vaccinated. next slide. so, again, in terms of what's been some of our progress to date, we are really having to report that we've made progress in the percentage of individuals who are 65 years and older who've completed vaccination. so we've got 82% of those 65 and older who've had at least one dose and 64% who have completed their series either having two doses or the one dose of j&j vaccines. next slide. so as you can imagine, as the department of public health, we

made it very an intentional focus that equity be at the forefront of all of our activities as it relates to vaccine. within d.p.h., the department of public health, we're committed to using our limited supply of vaccine that we received from the state really to focus on our most vulnerable communities knowing that most other san franciscans typically have health insurance and will be able to get their vaccine through their health care providers. this graphic gives you a sense of where within the city a vaccine has been administered on a neighborhood basis by the department of public health. again, just to show that the d.p.h., we are focusing on the most impacted and vulnerable

communities. and the darker the blue this graph shows, the higher percentage of individuals in those areas who receive their vaccine from the department of public health as opposed to another nond.p.h. provider. at the heart of our focus on equity, again, we've relied on our own health network having vaccine sites of many of our health network clinics, but also as important, we've partnered with a lot of community-based organizations to really get into the various neighborhoods and help us identify opportunities for vaccine roll-outs. next slide. so this is a slide that we've shared with you before and it really represents the one stop shop for looking at what we call our three-pronged approach for vaccination strategy across san francisco and going from left to right, we start with

our high volume sites and these are the sites that received a lot of attention very early on in our vaccine efforts where we partnered with major health systems within the city to form what we call the health system vaccine collaborative which is the partnership between the department of public health and the san francisco hospital counsel. and, with this partnership, you'll recall, we have three main sites. the site at city college where ucsf is the main provider and have included dignity health and other providers like one medical. then we've got moscone center side where kaiser has been the lead who's brought in inventicel. and our center pacific medical

foundation is the lead agency. and, in addition, there's a federal large volume site over in oakland at the coliseum. so this represented a lot of our early work, working with the health systems because again just to reiterate the way that the state set up the vaccine allocation process, most of the vaccine was and has gone to these large systems with only a smaller proportion of vaccine coming to local health jurisdictions like the san francisco department of public health. i really want to give a shout-out to the health systems who really stepped up and we have a lot of great success with our high volume sites and really the only limitation has just been the continued flow trickle of vaccines. but even despite that, we've had great success and i think

our numbers and stats reflect that. as we move to the middle section, the light blue, this represents our community focus away from the high-volume sites, but into more localized neighborhood sites and community sites. existing clinics around the city, both our own clinics, clinics that are part of the san francisco community consortium and others. and also some neighborhood sites, for example, the mission site at 24th and cap are run by ucsf. so, again, this represents the value of working with others to really have the greatest impact on vaccine roll-out across the city. another part of our community strategy is the use of mobile units. our mobile units, our teams,

paramedics or e.m.t.s and other health professionals who will go out to various facilities like homebound adults, people who are at home or some other behavioral health programs where they're not able to leave and actually provide in-home or on site vaccination services. and then finally, the third prong of our strategy was the collaboration with pharmacies both at the federal level with nursing facilities and now at the local level where vaccine is being made available to local pharmacies throughout neighborhoods. next slide. so as we begin to look forward to a time of peak vaccine distribution which we based upon our latest information

think will occur around may and june, we are predicting that we'll continue to see about 70% of the vaccine in san francisco would be administered out of our high volume sites. again, remember, those high volume sites are from our major health systems and they're the ones who are giving most of the vaccine. so we're looking forward to the collaboration through the hospital counsel and with the systems to keep those sites open so that we can have maximum penetration through those sites, but we also know that has we get more people vaccinated, it's going to become increasingly more challenging to make incremental improvements in overall vaccination rates and that's where we're going to really rely on our community strategy.

and you'll see where we expect to be at peak vaccine distribution, we expect to be able to be doing somewhere between 17,000 and 20,000 vaccines a day and you see an approximation of what the maximum volume is expected within the various sites. so about 12,000 a day at the high-volume sites going down to 500 a day through our mobile teams. and we're going to talk more about the mobile teams later on in the presentation. next slide. again, you know, we started this process back in december and january. really focusing on our high volume sites, getting them up

and running because we knew that's where the biggest bang for the buck was both in terms of vaccine source going to those other health systems, but also throughput in the ability to get a lot of people through a site at one time. but now, as vaccine is becoming a little more available and as we're maturing in our planning, we're moving more to our community vaccine strategy and within this strategy, our mantra is outreach, referral, and navigation and that there's no wrong door for access to vaccine and we know that's going to be critical again as we look into neighborhoods and areas that continued to have lower vaccination rates compared to the overall rates within the city. we know we'll be relying upon those community collaborations in order to get us over the top in terms of vaccine

distribution. next slide. so in terms of our community vaccine access planning, you know, the principles that we're working under include equity, again, we're looking at the data where we see gaps in equitable distribution of vaccine, working with community partners to help figure out what may be the causes of those gaps and then how we jointly come together to develop action plans in order to meet those gaps and get those vaccination rates up within those particular communities. next slide. so we want to share with you in the next few slides community action plans that we've developed for three of our communities where when we looked at the data, it showed that these communities were being underrepresented in terms

of vaccine distribution and vaccine uptake rates when compared to other parts of the city. so chinatown is one example of that. and just as you look at some of the data as of a few weeks ago in march, the chinatown vaccination rates for 65 and older were 67% compared to an overall city rate of 80% and for 75 years and older, chinatown rates were 42% compared to city rates of 72%. so when we looked at this data, it became clear we've got some deficits here and so we've began to implement our community action community strategy by doing targeted media events within the chinese media, working with c.b.o.s within the chinatown area to enlist their ideas, but also their support and also some of their staff to help really

figure out how we can vaccinate greater proportion particularly the older residents in chinatown. we've partnered with many chinatown providers. chinese hospital had been one of our first. we partnered with our own chinatown public health center, northeast medical service and some of the physician groups within chinatown and those that practice at chinese hospital. i want to thank you, dr. chow, for the connections and references you made to us. we followed up on all of those working with groups like c.c.d.c., chinatown korpgsz. nicos and others to really work with the community to help us figure out how we can better meet the needs to get vaccine out.

we've done some special events. back on march 24th, rather april 2nd, we did an event at the ping yuen senior development and we're able to manage there to provide vaccination on site for seniors who didn't feel comfortable leaving to another site for vaccination. next slide. similarly, we developed a community action plan for the tenderloin community. looking at that data as of march 25th in the tenderloin, 65-year-olds and older were at a 73% rate compared to overall 80% in the city and for 75 and older, they were slightly better. 70% compared to 72%. so we're using data to help drive our decision making and

our planning and in collaboration. so similar to chinatown, we worked with various c.b.o.s within the tenderloin. we worked with the board of supervisors staff to really identify key partnerships within the tenderloin and have held special events, for example, there was a community event at glide at the end of march and we've also had several events also currently planned for several shelter-in-place hotels and other supportive housing units within the tenderloin. so we'll be monitoring these rates and hopefully we'll be able to see some progress there. next slide. i want to return

next slide. so, again, focusing on our three-prong approach, high volume communities and quantities. just wanted to share some progress to date across these three strategies. so on yesterday as

dr. colfax communicated, we reached 6% of san franciscans who received at least one dose of vaccine. we reached on april 2nd our peak daily new dose administration of 13,000, almost 14,000 doses per day. we're now doing in san francisco well on our way to 20,000 a day once we have vaccine available. again, we're happy to report that 81% of san francisco residents sixty-five and older have received at least one dose of vaccine and 63% have complete the series. and also as dr. colfax mentioned, within our own san francisco health network, we just last week surpassed having done a 100,000 vaccines since

the middle of december which is really when you think about it, 20% of all the vaccines that have been administered within san francisco have been done by our own health network. and, also, other milestones both our southeast health center, part of our network and the 24th and capp clinic are run by ucsf each surpassed 10,000 vaccines each independently since they first started in january. and, we again mentioned our mobile teams. we've got four teams that are active and we have 19 mobile events planned as of april 4th. and some of those include -- and some of those that we've already done included those

launch and glide that we talked about. this past weekend, there were activity -- there was vaccine -- a vaccine clinic done at the lighthouse for the blind which represents part of our work with the disability community. again, knowing we needed to do something in addition to really provide access to that vulnerable community. and we've also sent our mobile team over to treasure island where they've worked with the fire department and have done vaccine clinics there. and, again, i mentioned we did the senior housing vaccine vaccine clinic at ping yuen center this weekend and there were 3,500 doses of johnson and

johnson administered there. looking forward, we've got another event planned in chinatown at ping yuen and we've got four neighborhood sites that will be launching across the city in terms of trying to increase our penetration within the communities. and those include excelsior at 20 norton on april 7th and then a second mission site on april 15th at 18th and shotwell. and then we've got two visitation valley sites planned to open on april 19th. 1099 sunnidale and 255 sunnydale. next slide. just as we started the presentation with data, i just want to share with you, these are three public tracker sites for our san francisco vaccine initiative. and so these are available on the website for any member of

the public just to see what is the latest and greatest in terms of data related to vaccine roll-out in san francisco. next slide. so, as i said it before, it's my privilege to really be the person here delivering this information, but i represent hundreds of other individuals across the department and the city and i really want to give a special shout-out to my partner in this effort dr. mary mercer who in her normal job is an emergency room physician at san francisco general, but for the last year has devoted her time to covid-19 and for the members of her team, dr. david spear. dr. liv quan and dr. jonathan spears and so many others who have just really come together

to i think give us the success that we've seen so far in san francisco. we know that while we have good numbers, we know we still have gaps in certain areas, certain communities and neighborhoods and so we're committed to working with our community partners can and look forward to when vaccine scarcity will no longer be. so i'll end it there and try to answer any questions you might have. >> president bernal: thank you, mr. pickens. before we go into commissioner comments and questions, mark, do we have any public comment? >> secretary: folks on the line if you'd like to make

public comment on this item, press star 3. no hands up, commissioners. no public comment. >> president bernal: okay. commissioners, any questions for mr. pickens. commissioner chow. >> commissioner chow: yes. i wanted to thank mr. pickens for such a comprehensive report on the vaccine and how the mobile teams are really working and particularly to thank you for the work that you're doing in chinatown also. so i just want to appreciate that the department is responding and that also now you're vaccinating within the s.r.o.s so i think you're going to see with the mobile teams and the ability to get into some of the housing a lot bet your uptick within all the

communities. thanks. >> you're welcome. thank you, dr. chow. >> president bernal: thank you commissioner chow. commissioner green. >> vice president green: i just want to thank everyone for this remarkable work. you know, as a practicioner who takes care of pregnant women, i have quite a few over 65 patients, i've gotten a lot of feedback from numerous patients who live throughout the city and have gone through virtually every vaccine site that you've got listed there and i have not heard a negative comment from anyone. in fact, i've heard multiple compliments and accommodations about how each one of these sites are run. it's frightening for people even to go to a site and i think it's just remarkable the leadership you've all shown and

the quality of care that all san franciscans now have really relatively easy access to. i think the department has done a superlative job and i just can't say enough about this and i think i speak for at least a few hundred people when i give you that feedback. >> president bernal: thank you, commissioner green. >> thank you very much. >> president bernal: commissioners, are there any other comments or questions? all right. mr. pickens, anything else you'd like to add? if not, we can move on to the next item. director colfax. >> director: i'd just like to thank mr. pickens for his effort. he runs the network in his normal job and it's been an incredible effort and to think

about where we were in december with so many health systems and the city needing to come together and the fact we have far exceeded our goal of 10,000 vaccines a day capacity in san francisco. we're already at 20,000. so i just thank mr. pickens and the team that he mentioned across the city that has made this a reality. now we just need the vaccines. so thank you. >> president bernal: thank you, director colfax and thank you again, mr. pickens, for that thorough presentation. i received my second vaccine dose yesterday after the city had expanded eligibility for people living with h.i.v. last month. i am experiencing a few small side effects like some fatigue and maybe feeling a little warm, but coupled with that i'm also experiencing gratitude for what this means not just for me but for my family and community and being able to get back to

resuming normal life as we continue forward in doing i think really a phenomenal job in vaccinating the people of san francisco. so i'm going to ask vice president green to take over this meeting and i'm going to sign off for the rest of the evening. thank you to d.p.h. staff, my fellow commissioners and members of the public who are watching and i'll see you all in two weeks. >> feel better. >> commissioner: feel better. >> commissioner green, would you like me to read out the items? >> vice president green: i think we're at general public comment. >> i will check. the folks on the line, please press star 3 if you'd like to make a general comment. star 3. no hands, commissioners. no public comment. >> vice president green: all right. well, then the next item on the

agenda is the finance and planning committee update. >> thank you, commissioner green. the finance and planning committee met right before the commission meetings and we had some pretty robust discussions about some of the contracts and as you see on the consent calendar quite a few of them are covid related and we are hoping that they will have a smooth pass through. so on the consent calendar, you will see like the contract report as well as -- i don't even remember how many contracts there are for your approval. >> secretary: i believe there's seven, commissioner. >> commissioner: thank you. and we also appreciate dr. ianna bennett to come to the committee to do the

presentations about racial equity and i think that it was really informing and i think that she will be presenting to the full commission soon. i'm done. >> secretary: so there we go. >> vice president green: so there's a series of action items we have on the consent calendar. is there any public comment on this item at this point? >> secretary: i will ask. thank you, commissioner. any public comment on item 8 press star 3 please. no public comment. >> vice president green: all right. any commissioner comments or questions on the consent calendar for action items?

>> secretary: i don't see any, commissioner. >> vice president green: all right. i guess we should vote on all of these as a bulk. >> secretary: yeah. we do need a motion and a second. >> vice president green: yes. is there a motion to approve the items on the consent calendar? >> commissioner: i move that we approve the items on the consent calendar. >> commissioner: i'll second. >> vice president green: roll call vote then. >> secretary: [roll call] >> vice president green: thank you. and thank you for this hard work. i know this is a very detailed meeting you had and a lot of items on the calendar. so thank you to the committee members and the presenters for going through all of this and answering our questions. next item is the charity care report. >> secretary: i will give you permission. i'm sorry. i'm late on that.

give me 10 seconds to give you that. >> great. thank you, mark. and i'm just checking, can you hear me? >> secretary: sounds good i see you and hear you. >> wonderful. i'm going to share my screen and full size the presentation. >> secretary: looks good. >> great. thank you, mark. good evening, commissioners. my name is max cara and i'm the program manager with the office of policy and planning. today i'll be presenting the final 2018-2019 charity care report. i'd like to thank members of the committee for their feedback as well as other commissioners who had questions and comments on the report. i shared responses with mark to those questions, but i'm happy to walk through those responses if desired at the end of the presentation. i also want to mention i'm joined today by several hospital representatives who

participated in the charity work group and available to answer questions about trends for their hospitals if needed. so for this presentation, i'll provide background on the charity care landscape. and then i'll go into the annual report and provide information on citywide and hospital trends. this is normally is compiled and presented on an annual basis, but due to delays from covid, this year combines two years worth of data. so the charity care ordinance in san francisco was passed by the board of supervisors in 2001. and, at the time, this law was the first of its kind in the nation. the ordinance has helped to increase transparency and accountability around charity care to report charity care data to the department of public health annually and notify patients of free and discounted services.

there are eight reporting hospitals that report their data to d.p.h. annually. these include dignity st. mary's and st. francis hospitals. chinese hospital. cpmc and mission hospital. these are kaiser, san francisco, ucsf and zuckerberg san francisco general. so with these eight hospitals together, d.p.h. is more able to accurately capture citywide trends. with regards to the notification requirements, every other year d.p.h. staff visit each hospital to conduct a review of the facilities compliance with the requirements. the next onsite review was to take place in 2020, but to reduce risks associated with covid, the review was conducted electronically. all were found to be compliant. so before i dive into the report, i wanted to highlight some of the events that have

occurred since the passage of the ordinance that have impacted charities in san francisco. in 2011, the healthy san francisco program was started. this is the city's health access program that provided uninsured residents access. in 2010, the affordable care act was passed. in 2014, u.c.a. implementation began, and, since then, we have observed an increase through the medical expansion and through covered california. this has been highlighted in previous reports. from 2017 to 2020, there have been continuous reports at the federal level to undermine access. these actions have included the repeal of the individual mandate along with public charge rules. the report presented today covers data from this time period. i'll talk more about the changes on the horizon. but starting in 2020, there have been significant events

that are likely to impact the charity care landscape. so moving on to the report itself, the report provides a high-level overview of charity here in our city and also show cases how transact differently. data is presented on both healthy san francisco and traditional charity care patients. for the report, representatives from each of the eight hospitals are engaged to discuss the draft we're engaged to discuss the draft prior to presenting to the health commission. and, as i mentioned at the start of the presentation, this report combines two years worth of new data. and lastly, for the first time, three years of health coverage and demographic data was collected for traditional charity care patients in order to better understand this population. so this slide highlights the

three major citywide key findings that we found based on the analysis of data and i'll go through each of these in subsequent slides. first, the report observed a rise in charity care for the first time since the implementation of the a.c.a. second, we continued to see distinctions between health san francisco and charity case populations. and, lastly, using new data, the report provides a better understanding of who traditional charity care is serving. so as i just mentioned for the first time since the a.c.a. implementation, there was an increase in charity care patients. the figure on the left shows a number of patients in charity care. over the previous two years, there has been an increase in patients by about 51%. the second figure on the right provides an overview of charity care utilizization.

as the different medi-cal services and the reimbursement received for those services, hospitals will typically absorb these costs. between 2017 and 2019, charity care expenditures increased by 30%. and the increases in medi-cal despite modest decline in medi-cal across the city. health care costs are increasing faster than the previous program. so when we dive deeper into the data for healthy san francisco in compareson to charity care, there are several differences to note.

this data supports the contention that healthy san francisco patients have greater access to primary, preventive care services. second, we see that the observed increases in charity care patients was driven largely by or almost all by traditional charity care patients. during this time, the number of charity care patients remained relatively stable. this suggests there are populations that continue to rely on san francisco for access to health care and for a.c.a. initiated health coverage. so based on an analysis of the data and the report and discussions with san francisco hospital representatives, multiple factors were identified that could be contributing to the increases in charity care observed in san francisco. i do want to note we have limited local data to pinpoint the exact impacts for these factors. first, hospitals are reported

as increased overall levels of service in san francisco they have increases in the amount of health care services provided, the price of health care has also increased. over the past two years, health care prices have increased by about 7%. another potential factor is that hospitals have reported that patients are remaining in acute care beds for longer periods of time. becoming increasingly difficult to obtain. the entire charity care expenditures. lastly, the largest provider of charity care in the city amended its charity care program in 2019. few changes expanded patient eligibility likely increasing the number of patients receiving charity care.

so the next section describes who is receiving charity care, receiving traditional charity care. the graph on the left shows reported residents otraditional charity care. the majority, the data also show that a large number of patients are homeless or have unknown addresses. the figure on the right is a map of charity care patients by supervisorial and in followling with years past, we see that a large number of patients are from districts with lower numbers of incomes. these neighborhoods also have some of the highest preventable emergency room visit rates. so as i noted earlier, new health coverage and demographic data was collected for the

first time. almost all hospitals submitted data for their patients. the figure on the left shows the racial ethnic breakdown on the patients. the patients are more likely to be hispanic latinx or black african american. when examined by coverage type as shown on the figure on the right, we show about 32% were uninsured and 68% have some form of medical coverage this data supports that many of the people receiving charity care are those who have coverage but unable to afford health care expenses. most of these newly collected data. over the past two years, we saw increases in charity care provided to those with medicare. and so stepping back and

looking at this new data in tandem with the data that's traditionally collected, we see though these receiving traditional care are also those likely to be experiencing some of the most significant health inequities and those who have higher needs and people experiencing homelessness and people in the lower socio-economic status. i'm now focused on the hospital-specific data. there are a number of factors that impact charity care patients. personal preferences among others. despite these factors, most hospitals paralleled city wide trends with regards to patients served. for example, as we see in this figure on the right, seven out

of the eight reporting hospitals experienced an increase in the number of charity care patients between 2017 and 2019. overall, s.f.g. as the county's safety net hospital continues to provide a large majority of charity care in the city and county. and about 61% of patients served. so, in this slide, the table shows each hospital's ratio of charity care cost to nit patient revenue and compares them to the state average. the ratio is a useful method for charity care contribution. overall, the ratios for all but one hospital are higher than the state average. csfg which is the largest provider of charity care has the highest rate at 9%. so, moving forward, there are state and federal policy changes along with global events that will influence

charity care. the on set of the covid-19 pandemic and its intended economic health affects will likely effect charity care. in january of 2021, a new federal administration assumed office and based on president biden's platform, restoring, strengthening, and expanding the systems in place will be a major priority. looming over this agenda is the uncertainty of the a.c.a. and whether the supreme court upholds, overturns the law which would have serious consequences for peoples' access to care. san francisco's charity care ordinance has enabled the collection of a long history of data since 2001. the continued collection of this data along with new demographic information will help to provide insight into the impacts of these ongoing and potential future changes. so this concludes my

presentation. i'd like to acknowledge our hospital partners who have participated in the work group and thank them for their continued support. i'd also like to thank you them for providing this new demographic data to help us better understand who our charity care programs are serving. and i'm now available for any questions and, as a reminder, all four representatives are available to answer specific data questions about their charity care programs. >> vice president green: thank you. is there any public comment on this item, mark? >> folks on the line, please press star 3 if you'd like to make public comment on the charity care report which is item 9. star 3. no hands up, commissioners. no public comment requests. >> vice president green: thank you so much, mr. gara and your team. that extensive report was well-detailed and i know how much work went into it and also we want to acknowledge your hospital partners who have not only done a superb job in

caring for all residents in san francisco, but also have added this very important demographic data which i think will help as we move forward with equity efforts. so we're very grateful to all of you for this work and each time you present the report gives us more depth and more understanding. so we're very appreciative. are there any questions or comments from the commissioners? commissioner chow. >> commissioner chow: yes. i want to echo your thanks to both the departments for continuing the report and to our hospital partners. the report of course began with a different perspective many years ago, but i think that the wisdom of actually continuing the report in government

started collecting data is the fact that we can here in our own city see what benefits we have from all of our hospitals and be able to acknowledge that and while it sort of began with an issue of whether or not non-profit hospitals are actually of value to their city, this, of course, shows the tremendous value that the hospital community is giving us. so not only the partnership there with covid administration of our vaccines which we just heard this afternoon, but also in providing basic care. it also helps highlight the amount of work also that our own county does in order to provide those services. and i must say one of the things that is interest i think right now is that we're able to

follow a trend that show that with the a.c.a., some of this went down, but now with insurance also becoming less affordable with a lot of deductibles or coinsurance, we're beginning to see even under medicare that this is now requiring that our hospital partners and our hospital itself needs to accommodate that under a charity type of situation. so it's not only whether medi-cal and medicare itself pay, but now we've got the problem of individuals in all insured categories trying to make due with the coinsurance. it will be interesting also in the coming year to see how covid may have affected this even though numbers of cases into hospitals have declined

whether or not with the loss of employment and all while there was some uptick in medi-cal how many were uninsured that really had to rely upon hospitals and whether emergency room services for the most vulnerable people, i should say, for those who did not have insurance actually be go up. so i think i want to commend the department for continuing the report and for all of our hospital partners who i hope they will continue to find value in this because i would think that this also helps to inform the work that they are going within their own hospitals so thank you. >> vice president green: thank you for those comments, commissioner chow. and thank you, mr. gara, for answering the questions we submitted in advance in such

detail. are there any other commissioner comments or questions? commissioner giraudo. >> commissioner giraudo: i also want to thank you for your excellent and detailed answers to the questions that i raised. i just have a couple of more questions for you. when you are reviewing the applications that charity care application, i am hoping and assuming that you're also very conscious of the reading level. i know in the past, again, in the past, i haven't seen the most recent c.p.m.c. application, but for the families that i have worked with, it was complex and the reading level was difficult.

and so just as you are reviewing all the hospitals' applications, i just would suggest that the reading level be in all languages, you know, looked at. my second comment in your excellent answers, again, is that d.p.h. also verifies that hospital admissions staff at each hospital campus provides patients with verbal notifications of the hospital policy describing charity care. my concern in this process is that when one is filling out information for admission to the hospital, one is not really necessarily in thinking about a charity care application especially if someone is

verbally giving that information and whether or not there might be another modality of alerting patients at some point in time, but i think when people are admitting, are signing papers to admit to the hospital is not necessarily the most emotionally stable time to consider whether or not charity care is something that they need. so it's just a thought and whether or not there's a card or something that can be given to patients rather than something on a verbal basis. just a couple of comments that i do want to thank you for the answers ahead of time. >> vice president green: and thank you for bringing that up, commissioner giraudo. i think it's a really important point about patients and making

sure they're informed that this is an option for some. are there any other commissioner questions or comments? i'm not seeing any. are you seeing any, mark? >> i do not see any, commissioner. >> vice president green: well, thank you very much. i guess we'll go to our next agenda item which is the second quarter financial report. >> and we have given you permission to share your screen. >> thanks. there's a slight delay and i'm just pulling it up now. >> any trouble, i have it as a backup on my computer. >> okay.

i think it's -- i think we're good and live right now. >> so evening commissioners. i'm happy to present the first quarter financials. how it that? >> much better. >> all right. i am pleased to present our second quarter financials. these represent our initial projections based on the actual

significant changes over the course of the fiscal year this represents our best expectation of what we believe at the six month report. and then, as a reminder, the budget and projection of the new covid project that was managed are not but we do discuss them at the end of this presentation and so taking them out of these financials just for clarity so you get a real sense of what our operation looks like.

so fiscally we're looking pretty much balanced here with overall an operating surplus of revenue of $7.5 million as well as a slight projected savings and expenditures of $1.4 million and operation of almost $9 million. in addition to that, as we discussed in our summary budget presentation, we had $51.7 million related to the relief of reserve due to the delay in the reduction to the disproportionate share to hospital reductions that we were expecting congress to implement in december. congress did act at the 11th hour and delayed those cuts for three years and so we are recognizing that additional good news in our financial and

so overall, d.p.h. is projected to have a total surplus of $60.6 million at our six-month board. there is one change in the reporting that i want to talk to the commissioners about because this is different from what i had said in our first quarter financial where i said all of our covid cost would be projected within the covid project, there are existing costs of operating staff that was pre-existing prior to the covid response that we had, but for accounting purposes, we now are reflecting under the public health administration division which actually has a covid project. what this does is it allows us to track the level of operating

support that we're putting towards the response that could serve as a potential match for eligible services and this supports some of the reporting we expect we'll need to do to differentiate new cost versus existing cost as of fema and other federal sources and state sources roll out reporting guidelines of potential reimbursements we have. overall, the reassignments are consistent with the 20-2021 budget with an existing division. for instance, if there was someone deployed at usfg and perhaps not working directly within vsfg operations but focuseded on an area specifically covid, it allows us not to overstate any of our cost within those existing

divisions. and so, what happens is the end result of this, because we do have a significant network of people deployed, what we do show in our financials, is a negative in the salary in spending because we've quote unquote overspent in salary and savings because we're charging existing people from other divisions into the public health administration, but then what you will see in all the other divisions is positive variances within our salaries to reflect that reassignment of cost from all these divisions down below up here. and, right now, our projected salary budget is fairly consistent with prior years at this point and we're right along the positive side of being balanced. these projections will vary over the course of the year and depend on the actual level of

deployments and there's also significant reconciliation process as we prepare cost reports. so between changes in deployments and reconciliation, these numbers may vary in subsequent reports. so just going on within specific divisions, you know, the public health administration division includes positive revenue variances of miner improvements in medi-cal administrative activities, the tcm activity as well as the $600,600,000 benefit that we received. there's positive favorable revenue of $9.1 million and

then with and the salary savings of $2.8 million wells some overspending of contracts, $5 million and a miner negative variant in materials and supplies. as i mentioned earlier, in addition to these variances, we will also be reflecting $51.7 million of surplus revenue outside of our regular operation. there was a delay of the district action the laguna primary care, the only variances that we're really seeing at this point are really related to the reassignment of deployment of staff of put to the covid projects. that's $3.5 million and $32 million at primary care

doctors. behavioral health, there's some improvement as well as a $20.9 million relief of reserve that we're recognizing due to the prior reconciliation process that the state has been accelerating over the last few years. so this represents a positive revenue balance there and, in addition, there's $13 million due to reassignment of cost, the covid project and the public health administration division. with general health services, there's minimal variances of, again, positive variants in salary and fringe benefits and nothing significant to report at the health and home division. and then, within the health network, you've seen this before where we've seen, we've had below budget revenues related to healthy san francisco and patient employer

fees as well as an assumption of city option fund disbursements that were $6.6 million was in our operating budget and there was an additional revenue that was expected to cover some of the covid sick pay programs. we are still working with the city attorney and the health plan should determine the best way forward in terms of recognizing how we can actually recognize the disbursements of these revenues and so until that legal issue is resolved, we are not going to assume the disbursement at this time. and then, again, same thing on the expenditure side salary and fringe benefits to the public health administration division. within public health, we have some miner revenue loss due to

patient revenue loss due to delay in implementing modules at the clinics due to the covid response as well as unseen potential losses due to reduce activity within environmental health. and then, again, $9.7 million of positive variances within the salary budget, again, being reassigned to the operating covid project. so the balance -- our projected balance is assumed as part of the controller's six months and the mayor's office is using that to offset the financial year. and release the $5.7 million of the reserve. and our current balance is $59.5 million at this time. and then, switching to the

covid project that is run citywide and, again, these figures are not represented in the figures that i discussed earlier, but these are considered a separate project that is managed citywide. this is a pretty complicated table that we have here, but what you see are sort of the major branches within our covid response and then we see what was sort of the original revised budget that we assumed and then an updated projection of costs and so what you'll see is that there's a positive what is actually a negative variant in the expenditures where initially the response would cost $61.7 million but it's increased to $725 million in these areas above most of this is related to the extension of

the sip hotels and not sort of stepping them down over the course of a year as originally planned, but continuing them, as well as continuing the feeding program that is managed by the human services agency. so negative variants of expenditures is offset by increased positive news related to fema and as well an additional revenue special grants and other departments, but this increase in fema is really related to the announcement by the biden administration that would retroactively increase the reimbursement of fema eligible costs of what was expected to be 75% of eligible cost to 100% and it was retroactive which resulted in a positive increase

in expected revenue for the city. so when we take into account what is a negative expenditure of and then the positive good news for fema and other areas, basically what we see is that there's $77.3 million in a positive variant within the city wide covid project that the mayor's office and controller's office will use to apply towards future covid response needs either this year or next year. specific variances related that we saw was really around the revenue side and then the i sort of mentioned this already of the biden administration's order to reimburse fema 75% of the cost and the increased rate

that was retroactive to january 2020 and is currently expected to go through september 2021. a portion of the revenue is also reserved for disallowances. specifically within the d.p.h. branches, some of the variances that we also see is related to vaccinations where we've currently have a projective $6.6 million in the current year and these are the six month financials which we developed probably in early february and so we will be working to revise this projection over the next few months. p.p.e. given the significant acquisitions we've received in the higher fiscal year as well as fema reimbursement, the revised budget is expected to be underspent by $37.4 million and offset some of the expenditures in other areas.

within d.p.h. branches, we also were projecting significant winter surge costs related to the hotels and hospitals. then, we will also revisit these projections in the nine months as we sort of look at where the level of case load is in a hospital capacity moving forward. so that was kind of a lot of information in a short amount of time and i am happy to answer any questions that you may have. >> vice president green: thank you so much unexpected. is there any public comment, mark. >> not on the line, commissioner. so there's no public comment. >> vice president green: okay.

any comments or questions from the commissioners. i see commissioner chow has his hand up. >> commissioner chow: i was just going to ask because the primary care numbers went down so much that they were put into the administration of covid, what has happened to the primary care surfaces? >> so i'm not sure if dr. hammer is still on the line, but there was -- we were running a fairly reduced operation as i understood on the primary care side as a result of the deployments of primary care staff to the covid response, but i know that it's something that we're looking to continue to expand back up to normal levels as we move forward with re-opening the city. >> yeah. this is hali hammer. jenn's right.

we did scale back our primary care operation really significantly in order to free up staff who could be deployed to the new covid related clinical services for which primary care clinical staff are best suited to staff those like testing, vaccination, others. and, also, we scaled back because during the early months of shelter-in-place, we were able to as we reported before, we were able to shift a lot of our in-person services over to telehealth and our ancillary services, we scaled back really tremendously. so very few nutrition visits, pharmacists, our dental services were scaled way back. so that's why i think you see

that really significant positive variance for primary care because so much of our staff and we had our podiatrists doing covid tests in the alternate testing sites. so so much of our primary care clinical staffed were deployed to the command center and to covid clinical services. >> commissioner chow: thank you. very much. are they back up to nearly the -- what level do you think we're back up to now? >> we are scaling back up slowly. it's been challenging because of the need to keep a number of staff deployed especially for, again, testing and vaccination in primary care. we are also continuing to offer a lot of our services over

telehealth because of our patient preference and because with social distancing, it's still the safest way to see people when we don't need to do an in-person visit. i would estimate that we're back up to about -- it's a little hard to know how to measure it because our ancillary services are still scaled pretty far back, but i would say we're probably at about 70%, but closer to 90% just for the primary care provider visits. >> commissioner chow: very good. thank you. >> vice president green: any other commissioner questions or comments? thank you so much, dr. hammer for elaborating on that. that's really very helpful. and no other comments or questions. we'll go to other business. is there any -- do the commissioners have any other

business? anything? no. >> looks like [inaudible] >> vice president green: and public comment. >> there's no one on the line still, so there's no public comment. thanks for asking. >> vice president green: well, we will go to the joint commerce committee as the committee reports. >> i believe dr. chow was going to give the update. >> vice president green: yes. >> commissioner chow: this is the joint conference committee at zuckerberg general. on march 23rd, the committee reviewed the informative presentations of the true north score card and the update and equality core measures update. both are very good providing information regarding the mentions that the hospital is tracking and the associated reimbursement. very nicely done. we also heard from dr. sue carlyell who is the dean of the school of medicine that gave a

presentation of the ucsf affiliation agreement. i think, mark, that would be good to distribute that to the commissioners so they can continue to be updated on the very important affiliation agreement we have with ucsf. >> yes, sir. >> commissioner chow: the committee also did review standard reports including the regulatory fairs report. we're still expecting the joint commission to attend. those of us on the committee are getting daily notes that they have not come yet, but they're expected really any day to do their survey for us, for accreditation. so it's been long overdue and they have said they were coming, so we're still expecting that sometime perhaps before even our next meeting. we also received a human

resources report. a good report of good hiring going on and the h.r. department's really doing a great job for not just nurses, but all our other staff that we need. the medical staff report, we approved the anatomic pathology rules and regulations. the opt apology rules and regulations and standardized and physician assistance in the rate treatment center in child adolescence support advocacy and resource center. and we concluded the report. and the report minutes. i think that concludes our report to you and i'll be happy to answer any questions if any of our colleagues want to add to the report. >> vice president green: are there any questions or comments from the other commissioners?

do we ask for public comment as well, mark. >> yes. thank you. there is still no one on the line. >> vice president green: . great, thank you, commissioner chow, for that thorough report. it really was an excellent meeting. so a lot of progress despite all the covid issues we've had. so thank you so much. the next item i guess is adjournment. so is there a motion to adjourn the meeting. >> commissioner: motion to adjourn. >> vice president green: is there a second? >> commissioner: second. >> vice president green: do a roll call vote. >> [roll call] >> vice president green: thank you all for all of the information you presented and for a very good meeting and we'll see you again in a few

weeks. >> and thanks for stepping in, commissioner. >> vice president green: you always give me great guidance. i'm never scared. >> all right. have a good night everyone.